, Question 1
During a focused cardiovascular assessment, which auscultatory finding is
most consistent with severe aortic stenosis rather than aortic sclerosis?
A. A soft, high-pitched systolic murmur at the right second intercostal
space without radiation
B. A harsh, crescendo-decrescendo systolic murmur radiating to the
carotids with a single S2
C. A mid-diastolic rumble at the apex with an opening snap
D. A pansystolic murmur at the apex radiating to the axilla
Correct Answer: B - A harsh, crescendo-decrescendo systolic
murmur radiating to the carotids with a single S2
RATIONALE
Severe aortic stenosis produces a harsh, crescendo-decrescendo
systolic murmur that radiates to the carotids and is often associated
with a single S2 due to loss of A2. Aortic sclerosis typically causes a
softer murmur without radiation. The other options describe mitral
stenosis (C) and mitral regurgitation (D), while A is more consistent
with a benign flow murmur.
Question 2
A patient presents with sudden onset of severe, sharp chest pain that radiates to
the back, along with a blood pressure differential between arms. Which
assessment finding is most critical to obtain next?
A. A 12-lead ECG to evaluate for ST-segment elevation
B. A chest X-ray to assess for widened mediastinum
C. A D-dimer assay to rule out pulmonary embolism
D. A troponin level to rule out myocardial infarction
Correct Answer: B - A chest X-ray to assess for widened
mediastinum
Page 2
, RATIONALE
The presentation is classic for aortic dissection, and a chest X-ray
showing a widened mediastinum is a key initial screening tool. While
ECG and troponin help rule out MI, they are less specific for
dissection. D-dimer is nonspecific and may be elevated in many
conditions.
Question 3
When performing a mental status examination, which component is most
directly assessed by asking the patient to recall three objects after five minutes?
A. Attention
B. Language
C. Recent memory
D. Executive function
Correct Answer: C - Recent memory
RATIONALE
The three-item recall test assesses recent memory (delayed recall).
Attention is tested by digit span or serial sevens. Language is assessed
through naming, repetition, and fluency. Executive function is
evaluated with tasks like clock drawing or verbal fluency.
Question 4
A patient with a history of cirrhosis presents with confusion and asterixis.
Which additional assessment finding would best support a diagnosis of hepatic
encephalopathy?
A. Fetor hepaticus on breath
B. Spider angiomata on the chest
C. Palmar erythema
D. Caput medusae
Correct Answer: A - Fetor hepaticus on breath
Page 3
, RATIONALE
Fetor hepaticus (a sweet, musty breath odor) is a classic sign of
hepatic encephalopathy due to mercaptan accumulation. Spider
angiomata, palmar erythema, and caput medusae are signs of chronic
liver disease but are not specific to encephalopathy.
Question 5
Which of the following best describes the purpose of the Homan's sign in a
modern vascular assessment?
A. It is a reliable indicator of deep vein thrombosis.
B. It is a sensitive test for arterial insufficiency.
C. It has poor sensitivity and specificity and is no longer recommended.
D. It is used to assess for varicose veins.
Correct Answer: C - It has poor sensitivity and specificity and is
no longer recommended.
RATIONALE
The Homan's sign (calf pain on dorsiflexion) has poor sensitivity and
specificity for DVT and is no longer recommended for routine
assessment. Current guidelines rely on Wells score and
D-dimer/ultrasound. The other options are incorrect as the sign is not
reliable for DVT, arterial insufficiency, or varicose veins.
Question 6
During an eye examination, a patient is unable to see the examiner's fingers in
the periphery but can see them centrally. This finding is most consistent with:
A. Glaucoma
B. Macular degeneration
C. Retinitis pigmentosa
D. Optic neuritis
Correct Answer: C - Retinitis pigmentosa
Page 4
During a focused cardiovascular assessment, which auscultatory finding is
most consistent with severe aortic stenosis rather than aortic sclerosis?
A. A soft, high-pitched systolic murmur at the right second intercostal
space without radiation
B. A harsh, crescendo-decrescendo systolic murmur radiating to the
carotids with a single S2
C. A mid-diastolic rumble at the apex with an opening snap
D. A pansystolic murmur at the apex radiating to the axilla
Correct Answer: B - A harsh, crescendo-decrescendo systolic
murmur radiating to the carotids with a single S2
RATIONALE
Severe aortic stenosis produces a harsh, crescendo-decrescendo
systolic murmur that radiates to the carotids and is often associated
with a single S2 due to loss of A2. Aortic sclerosis typically causes a
softer murmur without radiation. The other options describe mitral
stenosis (C) and mitral regurgitation (D), while A is more consistent
with a benign flow murmur.
Question 2
A patient presents with sudden onset of severe, sharp chest pain that radiates to
the back, along with a blood pressure differential between arms. Which
assessment finding is most critical to obtain next?
A. A 12-lead ECG to evaluate for ST-segment elevation
B. A chest X-ray to assess for widened mediastinum
C. A D-dimer assay to rule out pulmonary embolism
D. A troponin level to rule out myocardial infarction
Correct Answer: B - A chest X-ray to assess for widened
mediastinum
Page 2
, RATIONALE
The presentation is classic for aortic dissection, and a chest X-ray
showing a widened mediastinum is a key initial screening tool. While
ECG and troponin help rule out MI, they are less specific for
dissection. D-dimer is nonspecific and may be elevated in many
conditions.
Question 3
When performing a mental status examination, which component is most
directly assessed by asking the patient to recall three objects after five minutes?
A. Attention
B. Language
C. Recent memory
D. Executive function
Correct Answer: C - Recent memory
RATIONALE
The three-item recall test assesses recent memory (delayed recall).
Attention is tested by digit span or serial sevens. Language is assessed
through naming, repetition, and fluency. Executive function is
evaluated with tasks like clock drawing or verbal fluency.
Question 4
A patient with a history of cirrhosis presents with confusion and asterixis.
Which additional assessment finding would best support a diagnosis of hepatic
encephalopathy?
A. Fetor hepaticus on breath
B. Spider angiomata on the chest
C. Palmar erythema
D. Caput medusae
Correct Answer: A - Fetor hepaticus on breath
Page 3
, RATIONALE
Fetor hepaticus (a sweet, musty breath odor) is a classic sign of
hepatic encephalopathy due to mercaptan accumulation. Spider
angiomata, palmar erythema, and caput medusae are signs of chronic
liver disease but are not specific to encephalopathy.
Question 5
Which of the following best describes the purpose of the Homan's sign in a
modern vascular assessment?
A. It is a reliable indicator of deep vein thrombosis.
B. It is a sensitive test for arterial insufficiency.
C. It has poor sensitivity and specificity and is no longer recommended.
D. It is used to assess for varicose veins.
Correct Answer: C - It has poor sensitivity and specificity and is
no longer recommended.
RATIONALE
The Homan's sign (calf pain on dorsiflexion) has poor sensitivity and
specificity for DVT and is no longer recommended for routine
assessment. Current guidelines rely on Wells score and
D-dimer/ultrasound. The other options are incorrect as the sign is not
reliable for DVT, arterial insufficiency, or varicose veins.
Question 6
During an eye examination, a patient is unable to see the examiner's fingers in
the periphery but can see them centrally. This finding is most consistent with:
A. Glaucoma
B. Macular degeneration
C. Retinitis pigmentosa
D. Optic neuritis
Correct Answer: C - Retinitis pigmentosa
Page 4
